Huge Thank You to: Dr Rachel Hawes Northern Trauma Network GNAAS Blood Bikes Henry Surtees Foundation RVI ED & Blood Transfusion Staff

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2 Huge Thank You to: Dr Rachel Hawes Northern Trauma Network GNAAS Blood Bikes Henry Surtees Foundation RVI ED & Blood Transfusion Staff What s it all about? Management of Major Haemorrhage Military experience in Iraq and Afghanistan Blood on Board Logistics & clinical overview

3 Major Trauma Centre and surrounding Trauma Units Bypass protocol RVI & JCUH, LGI, PRH Advanced PHC 24/7 Haemorrhage control 24hr ED Cons cover Rapid access to CT scan Rapid access to theatre Blood & Labs Results Specialist ICM Increased number of survivors

4 Established 2001 Regional Service NE, N Yorkshire, Cumbria Large area Prolonged transfers Esp. Cumbria & N Northumberland 365 days per year Largest civilian air ambulance Full length access to patient Land in small spaces Daylight hours? 3 helicopters 2 cars Eurocopter Dauphin 3 identical Twin engine 140 km/hr 100% charity funded 4.5million per year Severely ill and injured

5 Began live operations in February To support hospitals across County Durham, Tyne & Wear and Northumberland. 100% charity funded 365 days per year (19:00 to 07:00) What we asked for? Delivery Route Timing Inclement Weather Plan

6 NICE Prehospital Fluids for Trauma Small volumes of fluid to support circulation Reduce blood clotting problems Prehospital Tranexamic Acid PGD Paramedic Prescribing Introduction of Major Haemorrhage Policy Pre 2006 Pre-hospital initiation of the Major Haemorrhage Policy Oct 2011 Pre-thawed Fresh Frozen Plasma Feb 2014

7 Hypotensive Resuscitation - (excluding head injuries) Radial Pulse Avoid excess clear fluids Dilution of clotting factor First clot is the best clot Mortality benefit 10-15% Haemostatic Resuscitation Balanced transfusion 1:1:1(:1) Tranexamic Acid (CRASH trial) Calcium Near patient testing Active warming

8 Pre-hospital initiation Reduce logistical delay Standardise blood product use Pre-thawed FFP avoid delay in balanced transfusion Next logical stage BOB?

9 Do we really need it? Haemorrhage leading cause of death 999 to Emergency Department 40mins 25% already have bleeding problems Is it effective? Integrated, seamless care, point of injury to hospital care Part of a bundle of care London results showed improved outcomes Is it safe? Do no further harm Can we afford it? GNAAS charity organisation

10 Consistent & Reliable 365 days per year Inclement weather Affordable for a charity Weight v fuel Air Worthiness Power source Legislation MHRA Access Protected Storage Constant temperature Monitoring & Data log Traceability Documentation 100% traceability Minimal waste

11 Supply & Preparation NHSBT, RVI, JCUH or NCUH? Whole Blood, PRC, FFP? Transport Route NHSBT Private Transport Blood Bikes (BB) Delivery No staff on airbase? Drop Off Locker Sign in/out procedure for BB and GNAAS Fax to RVI from each base monthly Collection of unused/ empty boxes Resupply after use Documentation Trace unit from donor to recipient From patient back to donor Cool box performance

12 3 part golden hour boxes All 3 parts given number All numbers to match on boxes Cool Boxes validated 2 units blood Data loggers to Temperature monitor

13 -20 c for 8 hrs Then 25 minutes at room temperature prior to use Stable for 72Hours?

14 All golden boxes validated in line with lab policy Ensure that boxes keep blood at less than 10 c

15 Temp monitor not activated Temp monitor activated and within temp Temp monitor activated and outside temp

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17 19.30hrs - Box collected by Northumbria Blood Bikes from RVI Box collected by Cumbria blood bikes from Penrith Boxes handed over at Haltwhistle Cumbria Blood Bikes delivers box t o Penrith Northumbria Blood Bike returns previous days box to RVI 21.30hrs - Box collect ed by Nort humbria Blood Bikes from RVI Box delivered to Teesside & Old box collected from Teesside Northumbria Blood Bikes then returns to RVI with collected box Cold Chain Boxes signed in / out drop boxes by Blood Bikes Signed out / in of drop boxes by GNAAS paramedic

18 Custom made Protection from Heat Frost Required Frost stat Electricity supply Access out of hours Security Key/ Key press Passport Cool Box exchange Signing In & Out Traceabilit y

19 Overview Checklist Challenge & Response Aide memoire Blood Prescription Info & Advice Sheet Leave at hospital Must happen Check unit Documentation Hospital Communication

20 Clinical GNAAS Audit Form Sharepoint to Rachel Liaison Links RVI JCUH Royal Preston Hospital Leeds General Infirmary Volume of use Outcome Data Linked to TARN & ISS Appropriate use & Reactions SABRE, SHOT (TACO) Traceability Logistical Brown & Red Tags Box tracking Temperature monitoring Cool Box Performance Wastage Inclement weather plan Summer hours

21 Patient 1 HEMS Age/Sex 58 year old male Mode of Injury RTA Van v HGV Injury Bilateral pneumothorax, liver lacerations, femoral fractures, acetabular fractures, scalp de-gloving RBC at Scene 2 units RVI Further Blood Usage 5 RBC, 4 FFP, 1 Plt Outcome Theatre ITU Ward 2 HEMS 53 year old male RTA Traumatic cardiac arrest, chest injuries 2 units North Tyneside Mortuary Died at scene 3 HEMS 43 year old Male RTA Car v van. Head, chest, pelvis and femoral injuries. Un-recordable BP, pulse 120, 2 units RVI 20 RBC, 22 FFP, 8 Cyo, 6 platelets Died 33 hrs post admission. 4 HEMS 84 year old female RTA Car v car Chest and abdo injuries, traumatic cardiac arrest, 2 units North Tyneside Mortuary Died at scene 5 HEMS 60 year old female RTA Head and chest injuries, traumatic cardiac arrest, 1 unit JCUH (2 nd unit did not have the full donation number written on brown tag so couldn t be given) 1 RBC, ITU and was alive 4 days post-accident 6 HEMS 81 year old female RTA Ped v car Chest injuries 2 units RVI 9 RBC, 9 FFP, 1 Plt, 2 Cryo, Died 27hrs after admission 7 HEMS 14 year old male RTA Ped v car Traumatic cardiac arrest 2 units JCUH 4 RBC, Died in ED 8 HEMS 23 year old female RTA Motorbike v car Chest and head injuries 2 units RVI 17 RBC, 16 FFP, 2 Plt, 4 Cryo Died in ITU (treatment withdrawn due to unsurvivable head injury) 9 HEMS 76 year old male RTA Pelvic and long bone injuries 1 unit JCUH 3 RBC, 4 FFP, 1 Plt Still on ITU as of 06/05/15 10 MERIT 24 year old male RTA Traumatic cardiac arrest 2 units RVI 4 RBC, 4 FFP. Died on ITU.

22 Cool Boxes 2,500 Drop Off Boxes 2,000 Belmont, Buddy Lite Fluid Warmers 3,500 Transport 2-5,000 Blood Bikes Free Inclement weather Transport (Initial quote 40,000) Private NHSBT Subsidised Hospital Delivery Blood Bikes (Free) Data Loggers 2,200 Wastage & Usage?? 130 per unit 2000 wastage? Charitable Donations

23 HEMS (Helicopter Emergency Medical Service) Concept started Early 2012 Sept 2014 equipment purchased GNAAS Teaching First wave 9am 4pm Thursday 27 th Nov 2015 BOB Dry Run Empty Box Friday 12 th Dec 2014, 10 days RVI Lab Teaching Week beginning 5 th January 2015 BOB Go Live 13 th Jan 2015!!!! First used 14 th Jan 2015 MERIT (Medical Emergency Response Incident Team) Go- Live (Fri & Sat night) Friday 8 th May 2015 First used 8 th May 2015 GNAAS Teaching Second wave - 9am 12pm Thursday 15 th Jan 2015

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